Your employer may offer different types of health plans, whose different rules may affect the way that you receive care.

Some common types of plans your employer could offer include:

(PPO) Preferred Provider Organization: A type of health plan in which you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

(HMO) Health Management Organization: A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

(POS) Point of Service Plan: A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

(EPO) Exclusive Provider Organization: A managed care plan in which services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

(HDHP) High-Deductible Health Plan: A health plan that features a limited amount of covered services.

Source: Healthcare.gov

How much will I pay for healthcare this year?

The amount you pay will be a combination of the following items:

The care you receive and any co-pays for doctors, facilities, tests, or procedures

Very importantly, the cost of the care you receive can go up if you utilize providers that are out-of-network for the plan you select or do not follow all of the plan’s rules

Your deductible, or how much you will pay before insurance covers any additional amount

The co-insurance rate, or the percentage you will pay for any medical care you receive after your deductible but before you reach your yearly out-of-pocket maximum or limit

Your out-of-pocket maximum or limit, which is the most you have to pay for medical care in a plan year—after you spend your out-of-pocket maximum on deductibles, co-payments, and co-insurance, your health plan pays 100% of the rest of covered benefits.

What is traditional Medicare?

Traditional Medicare is administered by the government and includes a few separate types of coverage that must be pieced together to provide complete healthcare coverage. Generally speaking:

• Medicare Part A covers inpatient services like hospital stays
• Medicare Part B covers outpatient services including medical procedures and equipment
• Medicare Part D covers prescription drugs
• Supplemental coverage, which is optional, covers additional items like co-pays

What is Medicare Advantage?

Medicare Advantage plans are administered by private insurers on behalf of the government. Medicare Advantage:

• Is also known as Medicare Part C
• Combines all the services offered through traditional Parts A and B
• Often includes Part D prescription drug coverage

Why are more people choosing Medicare Advantage?

• More and more consumers are choosing Medicare Advantage over traditional Medicare because these plans:
• Are more convenient, combining Medicare Parts A, B, and D into one package with a single insurance card
• Are more affordable than the combined cost of traditional Medicare and supplemental coverage
• Usually offer additional coverage not provided through traditional Medicare like routine dental and hearing care

What is Covered California?

Covered California is where Californians can purchase health insurance under the Affordable Care Act. It’s the only place where you can get assistance for your health insurance premiums from the federal government. Depending on your income and the individuals in your household, that means you may qualify for a discount on a health plan through Covered California.

What is Medi-Cal?

Medi-Cal is a statewide program that offers free or low-cost health coverage for children and adults with limited income and resources. This coverage is offered as a public assistance program by the state of California.

What is the difference?

Medi-Cal offers low-cost or free health coverage to eligible California residents with limited income. Covered California is the state’s health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it.

Health Insurance Plans

Be sure to check with your insurance company to verify specific coverage. Insurance companies frequently add new plans, and update provider networks and covered services under existing plans. Arch Health or Graybill may not accept every plan offered by your insurance company. We send bills directly to our patients’ insurance companies. Please bring your insurance information to every appointment. You can pay any balance due—including co-payments, which are due at your appointment—by cash, check, VISA, MasterCard or Discover. If your plan isn’t listed, it doesn’t mean that we don’t accept it, please call and verify.

Arch accepts THE FOLLOWING INSURANCE PLANS:

Aetna Elect Choice EPO, Managed Choice POS, Open Choice PPO, Select Choice HMO

• Anthem Blue Cross HMO, PPO, EPO
• APWU Health Plan
• Ben E Lect (Employer Driven Benefits Plan)
• Blue Shield PPO, EPO, HMO, CalPers Access+ HMO, Access+Hmo,
• Blue Shield FEP (Federal Employee Program) PPO
• Cash/Self Pay
• Cigna-Great West EPO, West Open Access, Great West PPO
• Cigna HMO, PPO, HMO POS, Network, Network POS, LocalPlus, Open Access Plus
• Community Care IPA (CCIPA) - Dual Eligible Plan
• Community Health Group (CHG) *(Excluding Urgent Care Services)
• Covered California
• Coventry/First Health
• Employer Direct Healthcare
• Government Employees Health Association (GEHA)
• Greater Tri Cities IPA (GTCIPA)-(limited to specialty departments: Orthopedic and General Surgery)
• HealthNet HMO, PPO, EPO, Salud Y Mas, Salud Y Con
• Health Smart Preferred Care PPO
• Humana Choice Care Plan
• Medi-Cal
• Medicare, RailRoad Medicare
• Medicare supplement (Medigap) plans
• Multiplan (includes Beech Street/Private Healthcare systems)
• Primary Care Associate (PCAMG)- limited to specialty department: General & Bariatric Surgery)
• Scripps Health Plan (limited to specialty department: General Surgery)
• Sharp Health Plan HMO, POS, PPO
• Tricare
• United Healthcare Core, Core Essential, Choice, Choice Plus, EPO, PPO, HMO
• ValuePoint Network
• Workers Comp (limited to Urgent Care and Specialty Departments)

Medicare Plans         

• AARP Medicare Advantage Walgreens
• AARP Medicare Advantage Secure Horizons Plan 4
• AARP Medicare Advantage SecureHorizons Premier
• AARP Medicare Advantage SecureHorizons Value
• AARP Medicare Advantage SecureHorizons Patriot (note: formerly the AARP Medicare Advantage SecureHorizons Essential)
• Sharp Direct Advantage
• Sharp SecureHorizons Plan by UnitedHealthcare
• UnitedHealthcare Medicare Advantage Assure
• UnitedHealthcare Chronic Complete Focus (HMO C-SNP)

GRAYBILL ACCEPTS THE FOLLOWING INSURANCE PLANS:

• Aetna
• Anthem Blue Cross
• Blue Shield
• Beech Street/ppoNEXT
• Humana
• Cigna
• Coventry/First Health
• HealthNet
• Medicare
• Medicare Supplement/MediGap
• Medicare Advantage HMO (through United Health Care/Sharp Community Medical Group)
• Multiplan/PHCS
• Sharp Health Plan HMO
• Sharp Direct Advantage HMO
• TRICARE for Life Prime
• United Healthcare